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Wang P, Zhang Y, Xu W, Zheng Y, Jia L, He J, He M, Chen L, Hao P, Xiao Y, Peng L, Chong W, Hai Y, You C, Fang F. Association between perioperative change in red cell distribution width and mortality in patients with brain tumor craniotomy. J Clin Anesth 2024; 97:111546. [PMID: 39029152 DOI: 10.1016/j.jclinane.2024.111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE An elevated preoperative red cell distribution width (RDW) is associated with adverse prognostic outcomes in various diseases. However, the correlation between changes in RDW (ΔRDW) and the prognosis following brain tumor craniotomy remains unclear. Accordingly, this study aimed to investigate the prognostic significance of perioperative changes in RDW in patients undergoing brain tumor craniotomy. METHODS This retrospective cohort study included patients undergoing craniotomy for brain tumors at West China Hospital, Sichuan University, from January 2011 to March 2021. We defined perioperative changes in RDW: group A (non-significant RDW changes, ΔRDW ≤0.4%), group B (drop in RDW, ΔRDW < -0.4%), and group C (rise in RDW, ΔRDW >0.4%). The relationship between the changes in RDW and all-cause mortality was analyzed by categorizing the patients according to perioperative ΔRDW (RDW at postoperative one week - RDW at admission). RESULTS The present study included a total of 9589 patients who underwent craniotomy for the treatment of brain tumors. A rise in RDW was significantly associated with increased mortality, with an adjusted OR of 3.56 (95% CI: 2.56-4.95) for 30-day mortality and 1.57 (95% CI: 1.33-1.85) for one-year mortality compared to those with non-significant RDW changes (ΔRDW ≤0.4%). Conversely, a decrease in RDW showed no significant association with 30-day mortality (adjusted OR: 1.04, 95% CI: 0.53-2.04) and one-year mortality (adjusted OR: 1.18, 95% CI: 0.92-1.53). These findings were also supported by restricted cubic spline, which shows that increases in RDW were significantly associated with lower survival rates compared to stable RDW levels during the follow-up period. CONCLUSIONS Among patients undergoing craniotomy for a brain tumor, a rise in RDW was associated with 30-day mortality and higher long-term mortality risks, even if patients' admissions for RDW values were within the normal range. It was worth noting that maintaining stable RDW levels during this period was associated with better survival.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
| | - Wenhao Xu
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yuxin Zheng
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao He
- Department of Anesthesia, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Pengfei Hao
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
| | - Liyuan Peng
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Berli S, Barbagallo M, Keller E, Esposito G, Pagnamenta A, Brandi G. Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:2781. [PMID: 38792323 PMCID: PMC11122382 DOI: 10.3390/jcm13102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objective: Sex-related differences among patients with aneurysmal subarachnoid hemorrhage (aSAH) and their potential clinical implications have been insufficiently investigated. To address this knowledge gap, we conduct a comprehensive systematic review and meta-analysis. Methods: Sex-specific differences in patients with aSAH, including mortality, delayed cerebral ischemia (DCI), and functional outcomes were assessed. The functional outcome was dichotomized into favorable or unfavorable based on the modified Rankin Scale (mRS), Glasgow Outcome Scale (GOS), and Glasgow Outcome Scale Extended (GOSE). Results: Overall, 2823 studies were identified in EMBASE, MEDLINE, PubMed, and by manual search on 14 February 2024. After an initial assessment, 74 studies were included in the meta-analysis. In the analysis of mortality, including 18,534 aSAH patients, no statistically significant differences could be detected (risk ratio (RR) 0.99; 95% CI, 0.90-1.09; p = 0.91). In contrast, the risk analysis for DCI, including 23,864 aSAH patients, showed an 11% relative risk reduction in DCI in males versus females (RR, 0.89; 95% CI, 0.81-0.97; p = 0.01). The functional outcome analysis (favorable vs. unfavorable), including 7739 aSAH patients, showed a tendency towards better functional outcomes in men than women; however, this did not reach statistical significance (RR, 1.02; 95% CI, 0.98-1.07; p = 0.34). Conclusions: In conclusion, the available data suggest that sex/gender may play a significant role in the risk of DCI in patients with aSAH, emphasizing the need for sex-specific management strategies.
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Affiliation(s)
- Sarah Berli
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Massimo Barbagallo
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Emanuela Keller
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
| | - Giuseppe Esposito
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Alberto Pagnamenta
- Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Intensive Care, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Division of Pneumology, University of Geneva, 1211 Geneva, Switzerland
| | - Giovanna Brandi
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Neurocritical Care Unit, Department of Neurosurgery, Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
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Shen JD, Yuan B, Zhang A, Zhou XM, Chen SJ, Deng JL, Zhang X, Jiang HY, Yu Q, Wu Q. Fecal calprotectin is a novel biomarker to predict the clinical outcomes of patients with ruptured intracranial aneurysm. J Stroke Cerebrovasc Dis 2024; 33:107634. [PMID: 38342274 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Intracranial aneurysm (IA) is a common cerebrovascular disease and the leading cause of spontaneous subarachnoid hemorrhage. Recent evidence suggests that gut microbiota is involved in the pathophysiological process of IA through the gut-brain axis. However, the role of gut inflammation in the development of IA has yet to be clarified. Our study aimed to investigate whether fecal calprotectin (FC) level, a sensitive marker of gut inflammation, is correlated with the development of IA and the prognosis of patients with ruptured IA (RIA). METHODS 182 patients were collected from January 2022 to January 2023, including 151 patients with IA and 31 healthy individuals. 151 IA patients included 109 patients with unruptured IA (UIA) and 42 patients with RIA. The FC level was measured by enzyme-linked immunosorbent assay. Other detailed information was obtained from an electronic medical record system. RESULTS Compared with healthy controls, the FC levels in patients with IA were increased (P < 0.0001). Patients with RIA had significantly higher FC levels than UIA patients (P < 0.0001). Moreover, the FC level in RIA patients with unfavorable outcomes was higher than in RIA patients with favorable outcomes. Logistic regression analysis showed that the elevated FC level was an independent risk factor for a 3-month poor prognosis in patients with RIA (OR=1.005, 95% CI = 1.000 -1.009, P = 0.044). CONCLUSION Fecal calprotectin level is significantly elevated in IA patients, especially those with RIA. FC is a novel biomarker of 3-month poor outcomes in RIA patients.
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Affiliation(s)
- Jun-Da Shen
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Bin Yuan
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - An Zhang
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Xiao-Ming Zhou
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Shu-Juan Chen
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Jin-Long Deng
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Hai-Yang Jiang
- Department of Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Yu
- Department of Clinical Laboratory, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing 210002, China.
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, China; Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China.
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Lukito PP, Lie H, Angelica V, Wijovi F, Nathania R, July J. Red-cell distribution width as a prognostic marker for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis. World Neurosurg X 2023; 19:100202. [PMID: 37181583 PMCID: PMC10172754 DOI: 10.1016/j.wnsx.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023] Open
Affiliation(s)
- Patrick P. Lukito
- Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
- Corresponding author.
| | - Hendry Lie
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Vanessa Angelica
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Felix Wijovi
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Regina Nathania
- Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
| | - Julius July
- Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Faculty of Medicine, Universitas Pelita Harapan, Jenderal Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia
- Corresponding author.
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Liu J, Wang J. Association between hemoglobin-to-red blood cell distribution width ratio and hospital mortality in patients with non-traumatic subarachnoid hemorrhage. Front Neurol 2023; 14:1180912. [PMID: 37388548 PMCID: PMC10303799 DOI: 10.3389/fneur.2023.1180912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023] Open
Abstract
Background In patients with ischemic stroke, low hemoglobin-to-red blood cell distribution width ratio (HRR) was associated with an increased risk of mortality. However, it was unknown in the non-traumatic subarachnoid hemorrhage (SAH) population. The purpose of this study was to examine the association between baseline HRR and in-hospital mortality in patients with non-traumatic SAH. Methods Non-traumatic SAH patients were screened out of the Medical Information Mart for Intensive IV (MIMIC-IV) database between 2008 and 2019. The Cox proportional hazard regression models were utilized to analyze the association between baseline HRR and in-hospital mortality. Restricted cubic splines (RCS) analysis was utilized to determine the relationship curve between hospital mortality and the HRR level and examine the threshold saturation effect. We further applied Kaplan-Meier survival curve analysis to examine the consistency of these correlations. The interaction test was used to identify subgroups with differences. Results A total of 842 patients were included in this retrospective cohort study. Compared with individuals with lower HRR Q1 ( ≤ 7.85), the adjusted HR values in Q2 (7.86-9.15), Q3 (9.16-10.16), and Q4 (≥10.17) were 0.574 (95% CI: 0.368-0.896, p = 0.015), 0.555 (95% CI: 0.346-0.890, p = 0.016), and 0.625 (95% CI: 0.394-0.991, p = 0.045), respectively. The association between the HRR level and in-hospital mortality exhibited a non-linear relationship (p < 0.05). The threshold inflection point value of 9.50 was calculated using RCS analysis. When the HHR level was lower than 9.50, the risk of in-hospital mortality rate decreased with an adjusted HR of 0.79 (95% CI: 0.70-0.90, p = 0.0003). When the HRR level was higher than 9.50, the risk of in-hospital mortality almost hardly increased with the increase in the HRR level (adjusted HR = 1.18, 95% CI: 0.91-1.53, p = 0.2158). K-M analysis showed that patients with low HRR levels had significantly higher in-hospital mortality (p < 0.001). Conclusion There was a non-linear connection between the baseline HRR level and in-hospital mortality. A low level of HRR could increase the risk of death in participants with non-traumatic SAH.
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Affiliation(s)
- Jiuling Liu
- Department of Neurology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Junhong Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Palabiyik O, Tomak Y, Acar M, Erkorkmaz U, Tuna AT, Suner KO, Ceylan D. Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:18-23. [PMID: 36820710 PMCID: PMC9937619 DOI: 10.1590/1806-9282.00210889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE This study aimed at investigating whether there is a relationship between 7- or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. METHODS We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. RESULTS We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7- and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7- and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. CONCLUSION Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7- and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.
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Affiliation(s)
- Onur Palabiyik
- Sakarya University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Sakarya, Turkey.,Corresponding author:
| | - Yakup Tomak
- Dogus University, Hisar Intercontinental Hospital, Department of Anesthesiology and Reanimation – İstanbul, Turkey
| | - Muberra Acar
- Istanbul Umraniye Training and Research Hospital, Department of Anesthesiology and Reanimation – İstanbul, Turkey
| | - Unal Erkorkmaz
- Sakarya University, Faculty of Medicine, Department of Biostatistics – Sakarya, Turkey
| | - Ayca Tas Tuna
- Sakarya University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Sakarya, Turkey
| | - Kezban Ozmen Suner
- Sakarya University Training and Research Hospital, Department of Intensive Care – Sakarya, Turkey
| | - Davut Ceylan
- Sakarya University, Faculty of Medicine, Department of Neurosurgery – Sakarya, Turkey
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Suprasanna K, HB S, Ravikiran SR, Jain I, Holla V. Hematological indices as predictors of intracerebral hematoma expansion detected on serial computed tomography. BRAIN HEMORRHAGES 2023. [DOI: 10.1016/j.hest.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Chalet FX, Briasoulis O, Manalastas EJ, Talbot DA, Thompson JC, Macdonald RL. Clinical Burden of Angiographic Vasospasm and Its Complications After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. Neurol Ther 2023; 12:371-390. [PMID: 36609962 PMCID: PMC10043150 DOI: 10.1007/s40120-022-00436-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Angiographic vasospasm (VSP), the narrowing of intracranial arteries, is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and often results in delayed cerebral ischemia (DCI) and cerebral infarction. The objective of this systematic review was to summarize the clinical burden of angiographic VSP and its related complications (DCI and cerebral infarction) after aSAH. METHODS Systematic searches of MEDLINE, Embase, and the Cochrane Library were conducted (in January 2021) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies reporting clinical outcomes of angiographic VSP and its related complications after aSAH. Study outcomes included measures of functional status (modified Rankin Scale [mRS], Glasgow Outcome Scale [GOS], extended Glasgow Outcome Scale [GOS-E], modified Barthel Index, or the modified National Institutes of Health Stroke Scale), cognitive status (Montreal Cognitive Assessment or the Mini Mental State Exam), clinical events (rebleeding), and mortality. Study selection, data extraction, and qualitative analyses were conducted. RESULTS Of 5704 abstracts reviewed, 110 studies were selected: 20 comparative and 39 regression-based studies were included in the qualitative synthesis, 51 descriptive studies were excluded. Most studies (51) were observational and conducted in a single country (53). The occurrence of angiographic VSP and its related complications after aSAH resulted in significantly poorer functional outcomes in three of nine comparative and 11 of 13 regression-based studies, measured by the mRS, and in five of six comparative and eight of nine regression-based studies, measured by the GOS and GOS-E. Angiographic VSP and its related complications were significantly associated with poor cognitive status in all five regression-based studies. Numerically or significantly higher mortality rates in patients with versus those without angiographic VSP and its related complications were reported in five of ten comparative studies and in eight of nine regression-based studies. Six studies looked at specific VSP populations (e.g., by severity or timing of VSP). CONCLUSION Patients with angiographic VSP and its related complications often had poor functional, neurological, and cognitive outcomes and reduced odds of survival both in hospital and at follow-up. We estimate that angiographic VSP and its related complications, DCI and cerebral infarction, lead to an approximately threefold higher odds of poor functional and cognitive outcomes, and about a twofold increase in the odds of death.
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Affiliation(s)
| | - Orestis Briasoulis
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | | | - Darren A Talbot
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | | | - R Loch Macdonald
- Community Health Partners, Community Neurosciences Institute, Fresno, CA, 93701, USA
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Zhao L, Zhang Y, Lin P, Li W, Huang X, Li H, Xia M, Chen X, Zhu X, Tang X. Postoperative red blood cell distribution width predicts functional outcome in aneurysmal subarachnoid hemorrhage after surgical clipping: A single-center retrospective study. Front Neurol 2022; 13:1036433. [PMID: 36619907 PMCID: PMC9817139 DOI: 10.3389/fneur.2022.1036433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Red blood cell (RBC) parameters are associated with outcomes following aneurysmal subarachnoid hemorrhage (aSAH), but their predictive value remains uncertain. This study aimed to detect the association between RBC parameters and functional outcome in aSAH patients undergoing surgical clipping. Methods This retrospective observational study included aSAH patients who underwent surgical clipping at Affiliated Hospital of North Sichuan Medical College between August 2016 and September 2019. The functional outcome following aSAH was assessed by modified Rankin Scale (mRS), and mRS 3-6 was defined as poor functional outcome. Results Out of 187 aSAH patients included (62% female, 51-66 years old), 73 patients had poor functional outcome. Multivariate logistic regression of admission parameters showed that World Federation of Neurosurgical Societies (WFNS) grade (odds ratio [95% CI]: 1.322 [1.023-1.707], p = 0.033) and white blood cell (WBC) (odds ratio [95% CI]: 1.136 [1.044-1.236], p = 0.003) were independently associated with poor functional outcome. In postoperative parameters, RBC distribution width (RDW) (odds ratio [95% CI]: 1.411 [1.095-1.818], p = 0.008), mean platelet volume (MPV, odds ratio [95% CI]: 1.253 [1.012-1.552], p = 0.039) and admission WFNS grade (odds ratio [95% CI]: 1.439 [1.119-1.850], p = 0.005) were independently associated with poor functional outcome. The predictive model including WFNS grade, admission WBC, and postoperative RDW and MPV had significantly higher predictive power compared to WFNS grade alone (0.787 [0.722-0.852] vs. 0.707 [0.630-0.784], p = 0.024). The combination of WFNS grade and WBC on admission showed the highest positive predictive value (75.5%) and postoperative RDW and MPV combined with admission WFNS grade and WBC showed the highest negative predictive value (83.7%). Conclusion Postoperative RDW is independently associated with poor functional outcome in aSAH patients undergoing surgical clipping. A combined model containing postoperative RDW may help predict good outcome in patients with aSAH after timely aneurysm clipping.
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Affiliation(s)
- Long Zhao
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,School of Clinical Medicine, North Sichuan Medical College, Nanchong, China,Neurosurgical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yi Zhang
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Ping Lin
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Weida Li
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Xingyuan Huang
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Hangyang Li
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Mingkai Xia
- School of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Xinlong Chen
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Xi Zhu
- Outpatient Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,*Correspondence: Xi Zhu ✉
| | - Xiaoping Tang
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,Neurosurgical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,Xiaoping Tang ✉
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10
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Cao W, Ren H, Song B, Liao Z, Li H. Red cell distribution width and Glasgow coma scale score as predictors of in-hospital mortality in maintenance hemodialysis patients diagnosed with spontaneous intracerebral hemorrhage. Medicine (Baltimore) 2022; 101:e31094. [PMID: 36281123 PMCID: PMC9592290 DOI: 10.1097/md.0000000000031094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Glasgow Coma Scale (GCS) score is being widely used as a useful predictor to investigate patients with head injury. High red cell distribution width (RDW) values have been independently associated with mortality and poor neurological outcome. However, there are few data available for Spontaneous Intracerebral Hemorrhage (SIH) in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the prognostic value of the combined measurement of RDW and GCS score in MHD patients with SIH. We retrospectively studied 46 MHD patients who was admitted to our hospital for nontraumatic SIH from October 2014 to May 2020. Data including demographic information, cause of renal failure, comorbidities at ESRD, clinical and laboratory parameters at admission were collected from medical records. Univariate and multivariate Logistic regression analysis were performed to identify independent risk factors of the in-hospital Mortality in Hemodialysis Patients with SIH. The receiver operating characteristic curve (ROC) and areas under the curve (AUCs) were determined. The sensitivity and specificity of independent risk factors were calculated for a range of different cutoff points. A total of 46 patients were enrolled in the study. The in-hospital mortality rate was 69.57%. We divided subjects into 2 groups based on the clinical outcomes. Compared with survivors (n = 14), non-survivors (n = 32) had longer hemodialysis vintage (P = .017), lower GCS score (P < .001), higher hemoglobin (Hb) (P = .032) and RDW (P = .009). In multivariate logistic regression analysis, GCS score (OR 0.719, 95% CI 0.546-0.946; P = .018) and RDW (OR 4.549, 95% CI 1.243-0.946; P = .018) were independent risk factors of in-hospital mortality in MHD patients with SIH. The area under the ROC curve (AUC) for GCS score was 0.849 (95% CI 0.729-0.970) while that for RDW was 0.743 (95% CI 0.596-0.891). The AUC for the combined prediction was 0.916 (95% CI 0.828-1.000), with a sensitivity of 90.63% and a specificity of 88.46%. In conclusion, high RDW and low GCS score were useful and independent poor prognostic markers for in-hospital mortality of MHD patients with SIH.
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Affiliation(s)
- Wen Cao
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Haoyuan Ren
- Department of Gastrointestinal Surgery, People’s Hospital of Deyang City, Deyang, Sichuan, China
- *Correspondence: Haoyuan Ren, Department of Gastrointestinal Surgery, People’s Hospital of Deyang City, Deyang 618000, Sichuan, China (e-mail: )
| | - Bin Song
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Zuchun Liao
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Haiyan Li
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
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Peng K, Koduri S, Ye F, Yang J, Keep RF, Xi G, Hua Y. A timeline of oligodendrocyte death and proliferation following experimental subarachnoid hemorrhage. CNS Neurosci Ther 2022; 28:842-850. [PMID: 35150055 PMCID: PMC9062564 DOI: 10.1111/cns.13812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS White matter (WM) injury is a critical factor associated with worse outcomes following subarachnoid hemorrhage (SAH). However, the detailed pathological changes are not completely understood. This study investigates temporal changes in the corpus callosum (CC), including WM edema and oligodendrocyte death after SAH, and the role of lipocalin-2 (LCN2) in those changes. METHODS Subarachnoid hemorrhage was induced in adult wild-type or LCN2 knockout mice via endovascular perforation. Magnetic resonance imaging was performed 4 hours, 1 day, and 8 days after SAH, and T2 hyperintensity changes within the CC were quantified to represent WM edema. Immunofluorescence staining was performed to evaluate oligodendrocyte death and proliferation. RESULTS Subarachnoid hemorrhage induced significant CC T2 hyperintensity at 4 hours and 1 day that diminished significantly by 8 days post-procedure. Comparing changes between the 4 hours and 1 day, each individual mouse had an increase in CC T2 hyperintensity volume. Oligodendrocyte death was observed at 4 hours, 1 day, and 8 days after SAH induction, and there was progressive loss of mature oligodendrocytes, while immature oligodendrocytes/oligodendrocyte precursor cells (OPCs) proliferated back to baseline by Day 8 after SAH. Moreover, LCN2 knockout attenuated WM edema and oligodendrocyte death at 24 hours after SAH. CONCLUSIONS Subarachnoid hemorrhage leads to T2 hyperintensity change within the CC, which indicates WM edema. Oligodendrocyte death was observed in the CC within 1 day of SAH, with a partial recovery by Day 8. SAH-induced WM injury was alleviated in an LCN2 knockout mouse model.
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Affiliation(s)
- Kang Peng
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA,Department of NeurosurgeryXiangya HospitalCentral South UniversityChangshaChina
| | - Sravanthi Koduri
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Fenghui Ye
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Jinting Yang
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Richard F. Keep
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Guohua Xi
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Ya Hua
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichiganUSA
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Ignacio KHD, Diestro JDB, Enriquez CAG, Pascual JSG, Medrano JMM, Omar AT, Legaspi GD. Predictive Value of Hematologic Inflammatory Markers in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2022; 160:e296-e306. [PMID: 35017073 DOI: 10.1016/j.wneu.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Our study aimed to determine the ability of hematologic markers (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio, and red cell distribution width [RDW]) in predicting delayed cerebral ischemia (DCI), modified Rankin Scale scores, and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS A retrospective observational 6-year review of medical records was conducted to identify all consecutive patients with aSAH admitted to the largest training hospital in the Philippines. Univariable and multivariable regression analyses were performed to determine the association of the biomarkers with the respective outcomes. Receiver operating characteristic curves were used to detect overall predictive accuracy. RESULTS A total of 222 patients with aSAH were included, of whom 11.71% developed DCI. Most patients with NLR ≥5.9 subsequently died (77 vs. 52%; P = 0.03). DCI was also associated with poor functional outcomes with higher modified Rankin Scale scores (3-6) on discharge (92% vs. 49%; P < 0.01), and longer duration of hospitalization (median, 20 vs. 13 days; P = 0.01). In receiver operating characteristic analyses, the value of RDW was predictive for DCI (area under the curve, 0.70; 95% confidence interval, 0.62-0.79; P < 0.01). The values of NLR (area under the curve, 0.67; 95% CI, 0.59-0.74) potentially predict functional outcome. RDW, NLR, and their combinations were poor discriminators of mortality. CONCLUSIONS Our study showed that some hematologic parameters analyzed could be of potential value as prognostic biomarkers in patients with aSAH. Hematologic biomarkers are widely available and practical parameters that may be of considerable clinical value in aSAH management, especially in lower-middle-income countries such as the Philippines.
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Affiliation(s)
- Katrina Hannah D Ignacio
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Jose Danilo B Diestro
- Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Canada; Département de radiologie, radio-oncologie et médecine nucléaire, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Clare Angeli G Enriquez
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Juan Silvestre G Pascual
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose Miguel M Medrano
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Abdelsimar T Omar
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Gerardo D Legaspi
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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13
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Cui Z, Liu C, Sun G, Huang L, Zhou W. A prognostic nomogram incorporating red cell distribution width for patients with intracerebral hemorrhage. Medicine (Baltimore) 2020; 99:e23557. [PMID: 33327308 PMCID: PMC7738053 DOI: 10.1097/md.0000000000023557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the second most common subtype of stroke with higher mortality and morbidity, and it lacks effective prognostic markers. The aim of this research is to construct newly valuable prognostic nomogram incorporating red blood cell distribution width (RDW) for ICH patients.We retrospectively analyzed 953 adult patients with ICH. The impacts of RDW on short-term mortality and functional prognosis were calculated using Akaike information criterion (AIC), Bayesian information criteria (BIC) and the area under the curve (AUC) respectively, which could be used to compare with Glasgow coma scale (GCS) and ICH score. The independent factors of prognosis were identified by univariate and multivariate logistic regression analysis. A nomogram based on RDW for nerve functional prognosis was further constructed and validated. Its clinical value was subsequently explored utilizing decision curve analysis.Cumulative clinical results were retrieved for 235 inpatients from Jan 2012 to June 2017. In 30-day mortality sets, GCS and ICH score had better prognostic performance than RDW (AUC: 0.929 and 0.917 vs 0.764; AIC: 124.101 and 134.188 vs 221.372; BIC: 131.021 and 141.107 vs 228.291). In 30-day functional prognosis sets, the consequences of evaluation systems were inconsistent. GCS was the best parameter for predicting outcome using AIC (262.350 vs 276.392 and 264.756) and BIC (269.269 vs 283.311 and 271.675). However, RDW was higher than GCS and ICH score considering AUC (0.784 vs 0.759 and 0.722). Age, GCS, RDW, platelet distribution width, and surgery were independent prognostic factors by multivariate logistic regression analysis, and those coefficients were used to formulate a nomogram. This nomogram can provide accurate prediction with the concordance index of 0.880 (95% CI, 0.837-0.922) higher than Harrell's concordance index of GCS system 0.759 (95% CI, 0.698-0.819) and RDW 0.784 (95% CI, 0.721-0.847). The calibration plots showed optimal consistency between bootstrap-predicted and the actual observed values of 30-day unfavorable prognosis. Decision curve analysis showed an increased net benefit for utilizing the nomogram.High RDW values are associated with an unfavorable outcome after ICH. The established nomogram incorporating RDW should be considered for a 30-day functional prognosis.
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Affiliation(s)
- Zhe Cui
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Tianjin Baodi Hospital, Tianjin Baodi Affiliated Hospital of Tianjin Medical University, Baodi District, Tianjin
| | - Chengwang Liu
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Tianjin Baodi Hospital, Tianjin Baodi Affiliated Hospital of Tianjin Medical University, Baodi District, Tianjin
| | - Guozhong Sun
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Tianjin Baodi Hospital, Tianjin Baodi Affiliated Hospital of Tianjin Medical University, Baodi District, Tianjin
| | - Liping Huang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province
| | - Weiwen Zhou
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
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14
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Li J, Dai L, Yu N, Li Z, Li S. Measurement of red blood cell size based on a lensless imaging system. Biotechnol Appl Biochem 2020; 68:1348-1356. [PMID: 33140447 DOI: 10.1002/bab.2057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
The variability in the size of red blood cells (RBCs) is an important additional diagnostic parameter for diseases, which has been established as a part of the complete blood count (CBC). The CBC can be performed using an automated flow cytometer, but it is too bulky and expensive for point-of-care testing. A miniaturized lensless imaging system is a competitive modality for a CBC, that is small and inexpensive. There are two challenges in developing a lensless imaging system for taking the CBC, which make the measurement of the RBC size very difficult: the diffraction effect and the low resolution. In this paper, the RBC radius measurement is replaced with a diffraction ring radius measurement. The diffraction ring radius is much larger than the RBC radius. This feature can improve the imaging resolution. Based on Fresnel diffraction, the relationship between the radius of RBCs and the diffraction fringes is analyzed. Finally, a complete measurement algorithm for determining the RBC size based on the lensless imaging system is given, which can be used to measure the variability in the size of RBCs. In our experiment, the maximum error is less than 6.74%.
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Affiliation(s)
- Jianwei Li
- Faculty of Automation and Information Engineering, Xi'an University of Technology, Xi'an, People's Republic of China
| | - Li Dai
- Faculty of Automation and Information Engineering, Xi'an University of Technology, Xi'an, People's Republic of China
| | - Ningmei Yu
- Faculty of Automation and Information Engineering, Xi'an University of Technology, Xi'an, People's Republic of China
| | - Zhengpeng Li
- Faculty of Automation and Information Engineering, Xi'an University of Technology, Xi'an, People's Republic of China
| | - Shuaijun Li
- Faculty of Automation and Information Engineering, Xi'an University of Technology, Xi'an, People's Republic of China
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15
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Liu H, Xu Q, Li A. Nomogram for predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage in the Chinese population. J Stroke Cerebrovasc Dis 2020; 29:105005. [PMID: 32807421 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Delayed cerebral ischemia is a serious complication of aneurysmal subarachnoid hemorrhage with debilitating and fatal consequences. Lack of well-established risk factors impedes early identification of high-risk patients with delayed cerebral ischemia. A nomogram provides personalized, evidence-based, and accurate risk estimation. To offset the lack of a predictive tool, we developed a nomogram to predict delayed cerebral ischemia before performing surgical interventions for aneurysmal subarachnoid hemorrhage to aid surgical decision-making. METHODS We retrospectively collected data from 887 consecutive eligible Chinese patients who underwent surgical clipping or endovascular coiling for aneurysmal subarachnoid hemorrhage. Patients who previously underwent surgery formed the training cohort (n = 621) for nomogram development; those who underwent surgery later formed the validation cohort (n = 266) to confirm the performance of the model. A multivariate logistic regression analysis identified the independent risk factors associated with delayed cerebral ischemia, which were then incorporated into the nomogram. RESULTS Delayed cerebral ischemia was identified in 158/621 patients (25.4%) in the training cohort and in 66/266 patients (24.8%) in the validation cohort. Preoperative factors associated with delayed cerebral ischemia were age > 65 years, modified Fisher grade of 3-4, ruptured aneurysm in the anterior circulation, Hunt-Hess grade of 4-5, high blood pressure on admission, and plasma homocysteine level ≥ 10 μmol/L. Incorporating these six factors in the nomogram achieved efficient concordance indices of 0.73 (95% confidence interval, 0.68-0.77) and 0.65 (95% confidence interval, 0.57-0.72) in predicting delayed cerebral ischemia in the training and validation cohorts, respectively. CONCLUSIONS Our model can help determine an individual's risk of developing delayed cerebral ischemia in the Chinese population, and thereby, facilitate reasonable treatment-related decision-making.
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Affiliation(s)
- Haonan Liu
- Department of Neurosurgery, Lianyungang Clinical College of Nanjing Medical University (The First People's Hospital of Lianyungang), 182 Tongguan North Road, Lianyungang 222002, China
| | - Qian Xu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aimin Li
- Department of Neurosurgery, Lianyungang Clinical College of Nanjing Medical University (The First People's Hospital of Lianyungang), 182 Tongguan North Road, Lianyungang 222002, China.
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Ghimire R, Shakya YM, Shrestha TM, Neupane RP. The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal. BMC Emerg Med 2020; 20:43. [PMID: 32456665 PMCID: PMC7249690 DOI: 10.1186/s12873-020-00337-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background Sepsis is a common problem encountered in the emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency rooms using present scores, which has several variables to calculate. Red cell distribution width (RDW) is an easy, cheap, and efficacious score to predict the severity and mortality of patients with sepsis. Methods This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among the patients age ≥ 16 years and with a clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in the study by using a non-probability purposive sampling method. Results RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I = 0.649–0.818; p-value = 0.000) as APACHE II (AUC of 0.728; 95% C. I = 0.637 to 0.819; p-value = 0.000) or SOFA (AUC of 0.680, 95% C. I = 0.591–0.770; p-value = 0.001). Youden Index was maximum (37%) at RDW value 14.75, which has a sensitivity of 83% (positive likelihood ratio = 1.81) and specificity of 54% (negative likelihood ratio = 0.32). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock, 24 died (22.9%) which had the odds ratio of 0.713 (p = 0.555, 95% C. I = 0.231–2.194). Overall mortality was 27.02% (n = 40). RDW group analysis showed no mortality in RDW < 13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to > 15.6 RDW group and 45.9% mortality in > 15.6 RDW group. Significant mortality difference was seen in 14 to > 15.6 and > 15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively. Conclusion Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.
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Affiliation(s)
- Rajan Ghimire
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Yogendra Man Shakya
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tirtha Man Shrestha
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ram Prasad Neupane
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Fogagnolo A, Spadaro S, Taccone FS, Ragazzi R, Romanello A, Fanni A, Marangoni E, Franchi F, Scolletta S, Volta CA. The prognostic role of red blood cell distribution width in transfused and non-transfused critically ill patients. Minerva Anestesiol 2019; 85:1159-1167. [DOI: 10.23736/s0375-9393.19.13522-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
This review provides a summary of the literature pertaining to the perioperative care of neurosurgical patients and patients with neurological diseases. General topics addressed in this review include general neurosurgical considerations, stroke, traumatic brain injury, neuromonitoring, neurotoxicity, and perioperative disorders of cognitive function.
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Spadaro S, Taccone FS, Fogagnolo A, Franchi F, Scolletta S, Ragazzi R, Fanni A, Marangoni E, Govoni M, Reverberi R, Volta CA. The effects of blood transfusion on red blood cell distribution width in critically ill patients: a pilot study. Transfusion 2018; 58:1863-1869. [DOI: 10.1111/trf.14759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care; Erasme Hospital, Université Libre de Bruxelles; Brussels Belgium
| | - Alberto Fogagnolo
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care; University Hospital of Siena; Siena Italy
| | - Sabino Scolletta
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care; University Hospital of Siena; Siena Italy
| | - Riccardo Ragazzi
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Alberto Fanni
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Elisabetta Marangoni
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Maurizio Govoni
- Blood Transfusion Service, Sant'Anna Hospital; Ferrara Italy
| | | | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
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